Provider First Line Business Practice Location Address: 
4680 YORK ROAD
    Provider Second Line Business Practice Location Address: 
    Provider Business Practice Location Address City Name: 
BUCKINGHAM
    Provider Business Practice Location Address State Name: 
PA
    Provider Business Practice Location Address Postal Code: 
18912-0401
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
215-794-3224
    Provider Business Practice Location Address Fax Number: 
215-794-1111
    Provider Enumeration Date: 
08/30/2006